Addressing the opioid epidemic with behavioral interventions for adolescents and young adults: A quasi-experimental design.

Abstract

Objective: While several behavioral interventions have shown efficacy in opioid use disorder treatment, little is known regarding which behavioral interventions work best for youth, and if treatment responses vary by developmental age or sex. We explored latency to first episode of opioid use among adolescents and young adults following opioid use disorder treatment initiation with: (a) adolescent community reinforcement approach (A-CRA), (b) motivational enhancement therapy (MET) combined with cognitive-behavioral therapy (CBT) or CBT alone (MET/CBT or CBT alone), or (c) treatment as usual (TAU; 12-step facilitation, supportive therapy). Method: Adolescents and young adults (N ϭ 785) entering treatment for opioid use disorder were followed for 1 year. Survival analysis was used to assess variation in latency to first episode of opioid use by treatment received, as well as moderation by age group and sex. Results: Those receiving MET/CBT or CBT alone, and TAU fared better than those receiving A-CRA. For adolescent males, those receiving TAU or A-CRA had poorer outcomes compared with those receiving MET/CBT or CBT alone, while no differences were found between treatments for female adolescents. Female young adults receiving TAU had lower hazard of opioid use compared with those receiving A-CRA, and MET/CBT or CBT alone, and male young adults receiving A-CRA had higher hazard than those receiving TAU, and MET/CBT or CBT alone. Conclusions: Findings highlight different treatments may be more efficacious for youth based on developmental age and sex. Clinicians working with young people with opioid use disorder should consider patients' developmental stage and sex when considering treatment approaches. What is the public health significance of this article?The present study demonstrated variance in latency to opioid use across three commonly used interventions for opioid use disorder, indicating motivational enhancement therapy combined with cognitive-behavioral therapy or cognitive-behavioral therapy alone, and treatment as usual (i.e., 12-step facilitation, general counseling) outperform adolescent community reinforcement approach. Notably, treatment outcomes varied by age and sex, underscoring the importance of targeted treatments for opioid use disorder.

Sex differences in factors predicting post‐treatment opioid use

“…Previous work has shown that age is a key risk factor for substance use disorder relapse when sex is taken into consideration [44,45]. This may be because adolescents and young adults are less inclined to see their substance use as problematic, and/or a poor fit of traditional addiction treatment approaches [25] and limited availability of developmentally appropriate recovery supports. Other work has noted that motives for opioid use change over the life‐course.…”

“…This faster progression may be attributable to the fact that women who use or misuse opioids are more likely to have co‐occurring psychiatric disorders than men, with mood and anxiety disorders being especially prominent [14,15,20–22]. In terms of treatment outcomes, results are mixed among men and women [23–25]. For example, in a clinical trial for adults with opioid dependence, no sex differences were observed in terms of opioid use outcomes; however, women reported greater functional impairment, greater psychiatric severity, and were more likely to endorse opioid use to cope with negative affect [24].…”

“…For example, in a clinical trial for adults with opioid dependence, no sex differences were observed in terms of opioid use outcomes; however, women reported greater functional impairment, greater psychiatric severity, and were more likely to endorse opioid use to cope with negative affect [24]. Further, in one of the only studies investigating treatment effects among adolescents and young adults, results indicated differential effects of treatment by age and sex [25].…”

Young adult drug interventions: a social marketing systematic review and research agenda

“…Eight of the 20 studies addressed exclusion criteria. For those that did report exclusion criteria, participants were excluded due to unwillingness to commit to the entire study (Hides et al, 2010;Smeerdijk et al, 2012), being older than the required age, lack of treatment data (Davis et al, 2019), pregnancy (Marsch et al, 2016), already enrolled in a substance abuse programme (Kurtz et al, 2017), not having a phone to be contacted (Mertens et al, 2014), selected a fictitious drug in screener survey (Christoff and Boerngen-Lacerda, 2015) and acute illness (Haller et al, 2014).…”

“…Most of the studies, however, targeted a subsample within the young adult population. The most frequently targeted market were college students (Amaro et al, 2010;Christoff and Boerngen-Lacerda, 2015), those entering or in treatment for drugs or psychiatric conditions (Davis et al, 2019;Hides et al, 2010) and nightclub attendees (Kurtz et al, 2013;Kurtz et al, 2017). The remaining studies targeted young adults living in Thailand (Galai et al, 2018), those with self-reported drug use (Goldman et al, 2019;Lianlian et al, 2017) and those in juvenile observation (Suwanphahu et al, 2016).…”